scholarly journals Prognostic relevance of exercise pulmonary hypertension for new-onset atrial fibrillation in primary mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Teramoto ◽  
M Izumo ◽  
S Kuwata ◽  
R Kamijima ◽  
T Suzuki ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Systolic Pulmonary Artery Pressure ◽  
Exercise Echocardiography ◽  
Primary Mitral Regurgitation ◽  
Exercise Induced ◽  
New Onset

Abstract Background/Introduction New-onset of atrial fibrillation (AF) portends poor prognosis in patients with primary mitral regurgitation (MR). However less is known about prognostic indicator for new-onset AF. Purpose The purpose of this study was to identify the prognostic relevance of exercise pulmonary hypertension for the new-onset AF in patients with primary MR. Methods Total of 114 consecutive patients with primary MR who underwent symptom-limited exercise echocardiography using supine-cycle ergometer were followed for new-onset AF over mean follow-up time of 3.6±2.6 years. Those with prevalent AF and pulmonary hypertension (estimated systolic pulmonary artery pressure ≥50mmHg) prior to exercise echocardiography were excluded from our analysis. We defined exercise-induced pulmonary hypertension (ExPHT) as those with peak estimated systolic pulmonary artery pressure (SPAP) ≥60mmHg or delta SPAP defined as differences between rest and peak SPAP ≥20mmHg. Results The mean age was 61±15 years old and 70 (61%) were male. Of those, 8 (7.8%) had mild MR, 32 (31.1%) had moderate MR, and 63 (61.2%) had severe MR. 60 (52.2%) patients had ExPHT. A total of 27 cases of new-onset AF were found during follow-up where the ExPHT group had higher prevalence of new-onset AF than the non-ExPHT group (35% vs. 11%, p=0.002). Those with ExPHT had significantly stronger association with shorter event-free survival time of new-onset AF (log-rank p<0.001, Figure). When adjusted for age, sex, body surface area, the American Society of Echocardiography MR grade, left atrial dimension, peak systolic blood pressure and heart rate, the multivariable Cox regression analysis showed that those with ExPHT had a hazard risk of 3.1 ([95% CI 1.1–9.1], p=0.039) for new-onset of AF. Conclusions Exercise-induced pulmonary hypertension predicted incident of new-onset AF in those with primary MR. Exercise echocardiography is expected to play an important role in decision making with regards to the optimal timing for surgical intervention in primary MR. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis

2016 ◽  
Vol 48 (6) ◽  
pp. 1658-1667 ◽  
Author(s):  
Adriana Stamm ◽  
Stéphanie Saxer ◽  
Mona Lichtblau ◽  
Elisabeth D. Hasler ◽  
Suzana Jordan ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Pulmonary Artery ◽  
Cox Regression ◽  
Early Stage ◽  
Free Survival ◽  
Right Heart Catheterisation ◽  
Exercise Induced ◽  
Wedge Pressure

The aim of the present study was to investigate the prognostic value of exercise haemodynamics measured during right heart catheterisation (RHC) in patients with systemic sclerosis (SSc) referred for evaluation of pulmonary hypertension.SSc patients undergoing RHC at rest and during maximal supine incremental cycle exercise were grouped into resting precapillary pulmonary hypertension (PHrest) (mean pulmonary artery pressure (mPAP) ≥25 mmHg, pulmonary artery wedge pressure <15 mmHg), exercise-induced pulmonary hypertension (PHex) (mPAP ≥30 mmHg and mPAP/cardiac output >3 mmHg·L−1·min−1 at maximal exercise), and without pulmonary hypertension (PHnone). Patients' characteristics, haemodynamics and follow up data were compared between groups.72 SSc patients were followed for median (interquartile range) 33 (15–55) months. Mean (95% CI) survival without transplantation estimated by Kaplan-Meyer analysis was 4.4 (0.8–2.9) years in PHrest (n=17), 5.2 (4.4–6.1) years in PHex (n=28) and 9.5(8.4–10.6) years in PHnone (n=27; p<0.05 versus others). In Cox regression models, the exercise-induced increase in mPAP (hazard ratio (HR) 1.097, 95% CI 1.002–1.200) and the coefficient of pulmonary vascular distensibility alpha (HR 0.100, 95% CI 0.012–0.871) controlled for age, but not resting haemodynamics predicted transplant-free survival.Among SSc patients with normal mPAP at rest, an excessive increase in mPAP during exercise and an impaired vascular distensibility may indicate an early stage of pulmonary vasculopathy, associated with reduced survival similar to resting pulmonary hypertension patients.

scholarly journals Left atrial filling index in prediction of exercise induced pulmonary hypertension in patients with asymptomatic primary mitral regurgitation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Zvirblyte ◽  
A Montvilaite ◽  
E Tamulenaite ◽  
A Saniukaite ◽  
JJ Vaskelyte
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Regurgitation ◽  
Left Atrium ◽  
Peak Stress ◽  
Recovery Phase ◽  
Left Ventricular ◽  
P Value ◽  
Systolic Pulmonary Artery Pressure ◽  
Bicycle Ergometry ◽  
Exercise Induced

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. In patients with chronic mitral regurgitation (MR), left atrium (LA) is one of the first cardiac structures, that are affected by progressive volume overload. Previous studies have shown that higher LA filling index (FI) could be a potential negative prognostic marker and it may provide additional information in cases where surgical valve correction is considered. Purpose. The aim of this study was to evaluate the connection between the LA FI and exercise–induced pulmonary hypertension (EIPH) in patients with asymptomatic primary moderate to severe MR. Methods. The study sample consisted of 50 patients (age 61.88 ± 12.88 years) with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) (&gt;60%). All of the patients underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. The ratio of the early–diastolic mitral inflow peak velocity (E) and LA reservoir strain was calculated as the LA FI. EIPH was considered as systolic pulmonary artery pressure (SPAP) ≥60 mmHg during peak stress. Results. EIPH was identified in 13 (26%) patients with primary asymptomatic MR. LA FI at rest, during initial and peak stress was higher in patients with EIPH (p = 0.041, p = 0.023 and p = 0.036, respectively). LA FI at rest (r = 0.334; p = 0.044), during initial (25W) stress (r = 0.371; p = 0.037) and during recovery phase (r = 0.408; p = 0.023), weakly correlated with SPAP during maximal achieved workload. In univariate logistic regression analysis, LA FI during initial and peak stress was significantly related to EIPH (Table 1). According to ROC analysis, LA FI &gt;6.46 during initial stress could predict EIPH with 70.0% sensitivity and 75.0% specificity (p = 0.023). LA FI &gt;9.59 during peak stress could distinguish the possibility of underlying EIPH with 60.0% sensitivity and 94.3% specificity (p = 0.036). Conclusions. Resting and exercise LA FI was higher in subjects with EIPH. LA FI during stress could be the potential predictor of EIPH in patients with asymptomatic primary MR and preserved LV EF. Table 1 Parameter β Chi-Square Odds ratio Standard error 95% CI p value LA FI at rest 1.21 3.549 3.271 0.106 0.984 - 1.489 0.071 LA FI during initial (25 W) stress 1.535 6.056 4.812 0.195 1.047 - 2.250 0.028 LA FI during peak stress 1.662 7.364 4.646 0.236 1.047 - 2.638 0.031 LA FI during recovery phase 1.257 3.998 3.139 0.129 0.976 - 1.619 0.076 LA - left atrium FI - filling index Abstract Figure. Picture 1

scholarly journals Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation

2015 ◽  
pp. 70-9
Author(s):  
Rina Ariani ◽  
Indriwanto Sakidjan ◽  
Budhi Setianto
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Hypertension ◽  
Multivariate Analysis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Persistent Pulmonary Hypertension ◽  
Post Operative Atrial Fibrillation

Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.

scholarly journals Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 10 (13) ◽  
pp. 2927
Author(s):  
Amaar Obaid Hassan ◽  
Gregory Y. H. Lip ◽  
Arnaud Bisson ◽  
Julien Herbert ◽  
Alexandre Bodin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Multivariable Analysis ◽  
National Database ◽  
Increased Risk ◽  
Periapical Abscess ◽  
The Relationship ◽  
Onset Atrial Fibrillation ◽  
New Onset

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

2021 ◽  
pp. 1-6
Author(s):  
Tong Feng ◽  
Guo Zhangke ◽  
Bai Song ◽  
Fan Fan ◽  
Zhen Jia ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Anomalous Origin ◽  
Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

scholarly journals Tricuspid regurgitation in ischemic mitral regurgitation patients: prevalence, predictors for outcome and long-term follow-up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ofir Koren ◽  
Henda Darawsha ◽  
Ehud Rozner ◽  
Daniel Benhamou ◽  
Yoav Turgeman
Keyword(s):  
Cohort Study ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Tricuspid Regurgitation ◽  
Ischemic Mitral Regurgitation ◽  
Lv Ejection Fraction ◽  
Severe Grade

Abstract Background Functional tricuspid regurgitation (FTR) is common in left-sided heart pathology involving the mitral valve. The incidence, clinical impact, risk factors, and natural history of FTR in the setting of ischemic mitral regurgitation (IMR) are less known. Method We conducted a cohort study based on data collected from January 2012 to December 2014. Patients diagnosed with IMR were eligible for the study. The median follow-up was 5 years. The primary outcome is defined as FTR developing at any stage. Results Among the 134 IMR patients eligible for the study, FTR was detected in 29.9% (N = 40, 20.0% mild, 62.5% moderate, and 17.5% severe). In the FTR group, the average age was 60.7 ± 9.2 years (25% females), the mean LV ejection fraction (LVEF) was 37.3 ± 6.45 [%], LA area 46.4 ± 8.06 (mm2), LV internal diastolic diameter (LVIDD) 59.6 ± 3.94 (mm), RV fractional area change 22.3 ± 4.36 (%), systolic pulmonary artery pressure (SPAP) 48.4 ± 9.45 (mmHg). Independent variables associated with FTR development were age ≥ 65y [OR 1.2], failed revascularization, LA area ≥ 42.5 (mm2) [OR 17.1], LVEF ≤ 24% [OR 32.5], MR of moderate and severe grade [OR 419.4], moderate RV dysfunction [OR 91.6] and pulmonary artery pressure of a moderate or severe grade [OR 33.6]. During follow-up, FTR progressed in 39 (97.5%) patients. Covariates independently associated with FTR progression were lower LVEF, RV dysfunction, and PHT of moderate severity. LA area and LVIDD were at the margin of statistical significance (p = 0.06 and p = 0.05, respectively). Conclusion In our cohort study, FTR development and progression due to IMR was a common finding. Elderly patients with ischemic MR following unsuccessful PCI are at higher risk. FTR development and severity are directly proportional to LV ejection fraction, to the extent of mitral regurgitation, and SPAP. FTR tends to deteriorate in the majority of patients over a mean of 5-y follow-up.

scholarly journals Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation

2021 ◽  
Vol 10 (1) ◽  
pp. e001270
Author(s):  
Jonathan James Hyett Bray ◽  
Elin Fflur Lloyd ◽  
Firdaus Adenwalla ◽  
Sarah Kelly ◽  
Kathie Wareham ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Community Setting ◽  
Cost Effective ◽  
Ventricular Rate ◽  
Service Improvement ◽  
Community Monitoring ◽  
Ventricular Response ◽  
Community Diagnosis ◽  
New Onset

BackgroundCommunity management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting.MethodsDuring the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician.ResultsSeventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF.ConclusionsWe have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.

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